Tadasu Fuji

A Fundamental Study of Normal Layer Structure of the Gastrointestinal Wall Visualized by Endoscopic Ultrasonography

The gastrointestinal wall could be separated into five layers or nine layers by means of the ultrasonic endoscope, and the histological structure of these layers was ascertained by comparing endoscopic ultrasonograms of resected specimens of the gastrointestinal tract with their corresponding histology. The results were as follows: With five layers of the gastrointestinal wall, the first and the second layer corresponded to the mucosa, the third layer was the submucosa, and the fourth layer corresponded to the muscularis propria. The first layer was a border echo demonstrated inside the mucosa. The fifth layer consisted of the serosa and a border echo visualized outside the serosa. When a thin layer was visualized at the same time in both the second and the fourth layers, the gastrointestinal wall was separated into nine layers in total. With nine layers of the gastrointestinal wall, the muscularis mucosae was composed of a thin layer in the second layer and a narrow layer between a thin layer in the second layer and the third layer. A thin layer in the second layer was a border echo visualized inside the muscularis mucosae. A thin layer in the fourth layer of the gastrointestinal wall consisted of a border echo and a connective tissue between the inner circular muscle and the outer longitudinal muscle.

A new therapeutic trial of secretin in the treatment of intrahepatic cholestasis

SummaryMany animal experiments have been studied on the choleretic effects of secretin. We intended to estimate secretin choleresis in human (15 patients) who had received PTCD or T-tube insertion into the common bile duct. Based upon these data of secretin and choleresis, secretin was administered to 11 patients with prolonged jaundice due to intrahepatic cholestasis in order to evaluate this as a new therapy for intrahepatic jaundice. As controls, eleven patients with intrahepatic cholestasis treated with steroid hormones and/or phenobarbital were used. In all cases with biliary drainage, secretin produced a remarkable choleretic effect with a high concentration of bicarbonate. In 9 out of 11 patients with intrahepatic cholestasis who were treated with secretin, levels of serum bilirubin decreased linearly and other liver function tests returned to the normal range. The mean values of T1/2 (number of days required for reduction by half) of serum bilirubin in 9 effective cases to secretin was 10.8 days. On the other hand, that in 11 effective cases treated with steroid hormones and/or phenobarbital was 23.2 days. These results suggest that secretin therapy may be an effective treatment for intrahepatic cholestasis.

Clinical Experience with Prototype Pancreatoscopes

Abstract: Peroral pancreatoscopy (PPS) was introduced at our institute in 1982, with the aim of improving diagnostic accuracy in patients with pancveatic diseases, and as a preliminary, procedure for therapeutic interventions to the pancreas. However, limitations in instrumentation permitted us to observe only the main pancreatic duct. This is a report of our experience with 2 types of peroral Pancreatoscopes and our findings in patients with chronic pancreatitis and pancreatic cancer.

Abstracts of selected papers presented at the 30th Annual meeting of the Japanese Society of Gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 30TH ANNUAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY October 20-22, 1988 -Kagoshima, Japan Chairman: Shuji HASHIMOTO, M.D.

Pancreatic Sphincterotomy and Pure Pancreatic Juice Collection for Treatment of Chronic Pancreatitis

Abstract: After our introduction of endoscopic pancreatic sphincterotomy for treatment of chronic pancreatitis in 1985, our interest has been focused to the value of pure pancreatic juice collection with or without pancreatic sphincterotomy for management of chronic pancreatitis.

Hepatocellular Carcinoma with Invasion of the Right Intrahepatic Bile Duct Observed by Peroral Cholangioscopy: a Case Report

A 48‐year‐old chronic alcoholic with previous hepatitis B virus infection presented with recurrent episodes of obstructive jaundice secondary to hepatocellular carcinoma. The obstructive nature of the jaundice was confirmed by the peroral cholangioscopic findings of a friable nodular mass partially obstructing the right hepatic duct, and by relief of obstructive signs and symptoms after endoscopic sphincterotomy freed the common bile duct of “dark greenish formed materials”.

Abstracts of selected papers presented at the 73rd general meeting of The Japanese Society of Gastroenterology

S OF SELECTED PAPERS PRESENTED AT THE 73RD GENERAL MEETING OF THE JAPANESE SOCIETY OF GASTROENTEROLOGY Tokyo, Japan, April 7-9, 1987 Chairman : Shinroku ASHIZAWA, M. D.

A case of primary hepatocellular carcinoma cured by anticancer chemotherapy

制癌剤投与により腫瘍組織が完全に壊死に陥ったと考えられる切除不可能な原発性肝細胞癌の1症例を報告した.患者は45歳の男性で右季肋部痛にて入院.著明な肝腫を認め,α-Fetoproteinが陽性で,肝シンチでは右葉下外側に広範囲の陰影欠損像が,また,肝動脈造影では右葉分枝に著明なTumor Stainが認められた.肝生検による組織診断はEdmondson II型の肝細胞癌であった.Mitomycin C (10mg)の固有肝動脈内注入を2回, 5-Fu(250～500mg)・MitomycinC(4mg)の全身性投与を週2回の割合で16回施行した結果,自覚症状及び肝腫の消失,α-Fetoproteinの陰性化,肝動脈造影所見の著明な改善を認めた.患者は治療中止約3カ月後に急性腎不全で死亡したが,剖検上,肝右葉に見られた8×5×7cmの厚い被膜で覆われた腫瘍組織は完全に壊死に陥っており,肝内肝外に転移巣なく,肝実質障害も殆ど認められなかった.本症例は,若し合併症がなかったならば,長期に生存が可能であったものと考えられた.